Fatigue & Chronic Fatigue

Fatigue affects most of us from time to time. It is one of the most-often cited symptoms I hear in my clinic, even if it’s not the primary reason most people seek out my care.

When fatigue has progressed to the point that you have a hard time functioning, it is called Chronic Fatigue Syndrome (CFS). It is usually accompanied by poor sleep, poor memory, and difficulty concentrating, and you may even feel feverish and have tender, swollen glands, as if you have an illness. CFS is also usually accompanied by achy muscles and/or joints, and often goes hand-in-hand with Fibromyalgia.

There are many reasons for fatigue, and I’m only listing the most common causes here:

Medical conditions should be ruled out first, such as anemia, thyroid disease, diabetes, or heart, lung, kidney, or liver issues. Most of these can be ruled out with some simple blood tests. Usually there will be other symptoms in addition to fatigue if this is the case.

If you aren’t getting enough sleep or the quality of your sleep is poor, of course you will feel fatigued. If that is the case, see Insomnia. If you are waking up to an alarm, you probably aren’t getting enough sleep. Not everyone needs 8 to 8.5 hours of sleep, but most people need that much, and a few will need more to have an optimal amount of energy.

Emotional challenges such as stress, depression, and anxiety can lead to fatigue. But emotional symptoms can also be symptoms of medical conditions, so be sure to rule out any obvious diagnoses before assuming your emotional symptoms don’t have a physiological basis.

Poor diet and insufficient water are two major causes of fatigue. Sugar and a lot processed, refined foods are some of the worst things you can eat that will cause fatigue.

Caffeine, alcohol, or other substances can lead to depletion of calcium, magnesium, potassium, B-vitamins and other nutrients, causing you to feel fatigued and to sleep poorly. Caffeine will cause an energy drop when you aren’t ingesting it, and a vicious cycle ensues as you ingest more caffeine to deal with the low energy.

Perhaps the most common cause of fatigue is pushing yourself too hard, for too long. If you work long hours, you are wearing yourself out over time. If you then come home and take care of a family, you are extending your work day even more. I have patients who complain about getting tired at 9pm. You are supposed to be tired at 9pm. Your cortisol levels (a steroid hormone released from the adrenal glands) are highest in the morning, and decrease throughout the day so that you can fall asleep at night, and are at their lowest around midnight. Overwork and emotional stress can keep your cortisol levels elevated throughout the 24-hour cycle, leading to sleeplessness, which leads to fatigue. Most mammals sleep much more than humans do in many of our current Industrial Age cultures. Many cultures take mid-day breaks and siestas, which is more of a normal biorhythm for mammals. Pushing through your fatigue eventually leads to CFS.

Pain, allergies, diarrhea, IBS, digestive problems, and candida, fungal, and parasitic infections can also lead to fatigue.

Solutions:

Quit pushing yourself so hard. You may not have a choice if you have to work two or more jobs to support your family, but do what you can to cut out unnecessary chores. (See the page on stress for more suggestions on how to do this.) I’d have to say though, that most CFS patients I see my office are Type-A personalities, and push themselves too hard by choice. When you quit pushing yourself, and aren’t overly-busy during all your waking hours it may feel uncomfortable at first (perhaps even cause anxiety), but once you start to feel better physically and emotionally, relaxing starts to feel good. Busyness/workaholism can be an addiction, and needs to be treated if that is the case.

Get more rest. This may mean closing your eyes (lying down if possible) for 15-30 minutes in the afternoon. Wind down at night by staying off the computer and avoiding stressful situations, in order to allow your cortisol levels to fall.

CFS will not be relieved by rest alone. When you first start to sleep better, you will likely feel more fatigued initially, perhaps for the first two weeks. Don’t let this alarm you; this is normal for someone who is suffering from fatigue. Your energy should start to pick up within a few weeks.

Stop eating junk food and processed foods to the extent possible. Fresh foods have a lot more nutrition, and therefore energy to power your body. Eat easy-to-digest foods such as soup and cooked vegetables (raw foods are hard to digest and take more energy). Even if you are able to switch to more fresh foods, I still recommend taking a multi-vitamin and multi-mineral since our food sources are depleted due to too-frequent crop rotations and long shipping distances to our grocery stores. Usually you will start to feel better within two weeks or less.

Drink more water if you aren’t drinking enough, or if you drink a lot of diuretics such as coffee. Drink about two quarts of room-temperature water per day (cold takes more energy), or more if you have a larger body mass or sweat a lot. A general rule of thumb for kids and adults weighing more than 100 pounds is your body weight multiplied by the number of ounces (i.e., 140 lbs. = 70 ounces). Drink at least one extra quart per day if it is very hot out, and extra water during and immediately after a work-out. If you drink too much water, you can deplete Vitamin B-1 (thiamine). Thirst is not necessarily a good indicator of whether or not you are dehydrated. Your urine should be a light yellow, unless you have just taken a multivitamin or B-vitamin supplement. Drinking more water can help you feel more energized almost immediately.

Consume less caffeine or give it up entirely. If you give up caffeine, you will feel more tired initially; it takes about two weeks for your energy to even out. Drinking less alcohol will also help.

If you are mildly to moderately fatigued, mild to moderate exercise can help you feel much better. This may mean anything from 15 minutes to an hour, three to seven days per week. Just going for a walk on your lunch break can reduce stress and boost your energy. If you have CFS, however, this much exercise initially can be detrimental. Five minutes, three times per week may be all you can handle without increasing your fatigue instead of boosting your energy. The trick is not to walk too far (meaning until you are fatigued), and then have to walk back exhausted. I recommend starting with 5 minutes out, and 5 minutes back. If that feels good, you can gradually increase your distance over future days. Cut back again if you are having bad days. The tendency of Type-A’s is to overdo everything, including exercise. This is not a case of “more-is-better,” but rather “less-is-more.” You have to resist the urge to do too much (I’ll address that more below).

Acupuncture and Chinese herbs treat fatigue very successfully, and your practitioner can give you dietary and other suggestions to improve your energy. An acupuncturist can also treat underlying conditions that cause fatigue. Acupuncture can also successfully treat CFS, but it is very easy for a practitioner to over-treat the CFS patient, so look for a practitioner that understands this significant difference. When a patient comes to my office for CFS, I initially use 10 needles or less, and only leave them in for six minutes at most, with no stimulation, using my smallest diameter needles. If you are wiped out after your treatment, it was too strong for what your body could currently handle. It is normal to feel relaxed after your acupuncture treatment, and perhaps want to go to sleep, and you may even feel worse initially before you feel better, but there is a difference between that and feeling totally wiped out. Many CFS patients know the exact moment the needles need to come out before it is too long for them, and I pull the needles when they tell me they’re ready to come out. I always err on the side of caution with my CFS patients, and if they felt wiped out after a treatment, for the next treatment I use even less needles and/or less time. I also don’t prescribe herbs initially, because a CFS patient’s digestive system is too weak to digest herbs. I only prescribe easy-to-digest foods, a multi-vitamin and multimineral, homeopathics, and very minimal exercise for starters. I may add in a supplement called Cortisol Manager three to four weeks into treatments, when my patient starts to gain energy. Whatever type of practitioner you choose to see, make sure they don’t over-treat you with too many herbs or other types of treatments.

One big caution for CFS patients: As I mentioned above, most people who have CFS developed it over time by pushing themselves too hard for too long, until their body simply gave out and wouldn’t allow them to push anymore. When patients start to gain energy from the acupuncture treatments and/or other suggestions, the first thing they typically want to do is to get busy again and burn up that newly-recovered energy. No matter what your treatment, whether it’s acupuncture or something else, resist the urge to get busy again using your small energy reserve. You need to conserve it and build it up into more energy through a continually improving diet and rest. After a couple of months, if you have conserved enough energy, you will be able to “spend” some of that energy, as long as you don’t draw down your account too much. Think of it like a bank account that earns interest on $2500 and above, but only as long as you keep that minimum in the account. Dip below $2500 and not only do you not earn interest; you have to pay a fee to maintain the account, which depletes your account and makes it harder to get above the $2500 again. In other words, once you get your “energy” account up to the minimum threshold, you can choose to spend the “interest” wisely, but dipping below the minimum threshold will deplete your account and make it harder to reach your needed “energy threshold” again. I don’t usually nag or harp at my patients, but this is an exception. I remind them once or more per treatment not to spend their energy reserves, or they can be back to almost where they started. I find CFS patients need this constant reminder and accountability to be able to resist the “urge to spend.”

Disclaimer: The Food and Drug Administration has not evaluated these statements. Information on this web site is provided for informational and educational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. The products and information are not intended to diagnose, treat, cure, or prevent any diseases or, medical problems. Nutritional benefits may vary from one person to another.